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Extreme alkalaemia with mixed alkalosis due to suspected acute-on-chronic respiratory alkalosis
  1. Brian Nohomovich,
  2. Thales Gomes,
  3. Alana Pinheiro Alves and
  4. Alexandra Elizabeth Ortiz
  1. Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
  1. Correspondence to Dr Brian Nohomovich; bnohomovich{at}


Herein we present a case of severe alkalaemia (pH 7.81) due to suspected acute-on-chronic respiratory alkalosis in a patient with chronic anxiety and metabolic alkalosis secondary to emesis. The patient was managed in the intensive care unit with significant improvement and discharged in stable condition. The case report emphasises considering a broad differential of aetiologies that can cause acid–base status derangements and identifying the appropriate therapeutic approach.

  • Intensive care
  • Medical management
  • Anxiety disorders (including OCD and PTSD)
  • Fluid electrolyte and acid-base disturbances

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  • Contributors BN is the lead author and is responsible for the design of the case report, planning, drafting, and writing of the case, research, and final editing. He is also the corresponding and submitting author. TG was part of the team that oversaw the patient, conducted research on metabolic alkalosis and drafted the sections regarding metabolic alkalosis. He also directly edited the overall final draft. APA directly researched the topic of metabolic acidosis and reflected on how it related to our case. She drafted that part of the manuscript and participated in the final editing process. AEO directly oversaw the patient, drafted the learning points, and participated in editing the overall document and final edits. All authors participated in the final editing and all authors agree to assume responsibility for the accuracy of this document.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.